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I'm bipolar and I'm experiencing depression that cannot be helped by mood stabilizers. I'm taking Lithobid and Depakote. A dr told my mom once that I shouldnt ever be on an antidepressant. So what kind of hope does that leave for me??

I just tried adding Cymbalta but had increased anxiety so quickly got off it.

I've been on a LOT of the ADs before and I really dont ever remember any of them helping... but then again the only time I've been on an AD WITH a Mood stabilizer was Lamictal 200mg with Effexor XR 150mg. Eventually I made a serious suicide attempt on that combo (but it was working for quite a while).

what kind of hope is there for a bipolar who gets REALLY depressed for long periods of time? this cant go on like this.

ps very anxious too :);)

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IIRC, Effexor has a risk of suicide, so that's not a great surprise. It may be time to try the other ADs again with lamotrigine. Zyprexa is also used for treatment resistant depression, and plays nicely with lamotrigine (well, it does for me, at any rate).

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The meds my husband uses are lamictal, zyprexa and seroquel. He takes the lamictal every day (duh) and the others PRN. Lamictal is what helped him out of a horrible suicidal depression. They tried giving him Wellbutrin and depakote, but that just made him suicidal and wired.

How old are you Ammity? If you are still a teenager, the contantly changing hormones can make finding the right combo very difficult. And once you are done being hormonally deranged, things that did not help in the past may work for you without all the extra puberty stuff.

Also, are you on birth control? From reading other posts I gather that can mess with your meds as well.

Sounds like you need a LONG talk with your pdoc.

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Effexor is the Drug From Hell for BP's,mostly because it hikes up your anxiety to unacceptable levels. I am always amazed when I see someone here listing Effexor as part of their current cocktail.

Anyway, Wellbutrin is an option b/c it doesn't seem as triggering for bipolar types as the other AD's. Dee's right though - a combination of a safe AD with an AC (anticonvulsant used as mood stabiliser) might do the trick. But there are many options you can try... write down your concerns and get to your pdoc asap.

Good luck

Skittle

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Hiya-

You didn't mention specifically if you've tried any SSRIs, or which ones you've tried if any.

My pdoc put me on a cocktail of Lamictal, Seroquel, Paxil, and WB during a hospitalization for bp depression and it worked really well until I pulled out of the depression a few months later (I'm usually manic), and then we had to switch up my meds really quickly because I started to get manic.

Anyway-

I'm also an example of someone with anxiety issues. I have horrible anxiety issues. Paxil was a wonder drug for me. It never stimulated depression- it helped so much with making me feel better in the depression and anxiety departments, and I just loved it in general. I was up to 60mg at one point (normal dose being 20mg). I just love the stuff.

It is in my list of EX Meds because I was getting into a manic phase, which I'm still fighting to stay out of, and also because I felt I was "addicted". You should be aware that there is the chance of developing a "withdrawl syndrome" when you stop taking Paxil. Some people get it and some don't. Some people avoid it with a normal decrease and some, like me, need slow, micro-dosage decreases to avoid side effects (like relapse).

If you haven't tried it already, talk to your pdoc about Paxil.

I don't think that there is ever a reason to make a blanket statement that ALL AD drugs should be out of the question, unless you're the ultra-manic type. There are so many formulations and our body chemistries are all so different. You never know what will do the trick.

WZ mentions that birth control can mess with your meds. This can obviously be for better or worse, or neutral. For me I'm on a stable substance for me that helps me out in the mood department and I back it up with condoms due to the anticonvulsants I take (they possibly reduce effectiveness of the Pill). The Pill can really help. That was true when I was in my teens as well. I've taken the Pill or other forms of hormonal contraception since I was 16.

Oh yes, and Effexor is from HELL. I hated it. It made me throw up.

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"Effexor is the Drug From Hell for BP's,mostly because it hikes up your anxiety to unacceptable levels. I am always amazed when I see someone here listing Effexor as part of their current cocktail."

I love my current cocktail. I have been on it for almost two years and I have absolutely no bipolar symptoms anymore. It is amazing- 38 years of hell and we hit upon this combo and I'm happy, and steady, and normal. I cannot stress enough how fabulous this particular combination has been for me:

300mg Effexor XR

200mg Lamictal

100mg Zoloft

1 mg Risperdal.

I know that this combination is not supposed to work, but it works perfectly for me. When I had bipolar symptoms, my depression was severe and it took that much AD to pull me out of it.

My point is that mileage definitely varies and it doesn't matter if Effexor is supposed to make BP anxious, or if most ADs are suppose to increase the risk of mania. What matters is what works for you. I hope you have a doctor that is willing to at least try some different ADs to see if they help

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Ok to answer some of your questions.

1. I am not a teenager 2. I'm not using birth control at the moment 3. i've been on paxil, prozac (terrible anxiety), zoloft, celexa, lexapro, wellbutrin (Mania creeps up REALLY fast with that one), anafranil, effexor, pamelor, cymbalta, strattera, decipramine (got manic in the first few days of it).

Seroquel makes me retarded. Geodon drives me up the wall with anxiety. Lamictal just doesnt keep me from depression, Topomax drives me up the wall with anxiety, I felt extremely weird and yuck on Trileptal.

Ok so you must know only 2 of these have been tested along witha mood stabilizer. And those were Effexor and Cymbalta. Now I'm trying Lexapro again while on the Lith and Dep.

My biggest problem is that my depression slows me down so much that I have no energy, so all I want to do is sleep. But if I add anything for tiredness, you know what I get... that's right, you guessed it! anxiety!

i live in a lovely world. they should have let me die when they found me. fuckin dicks.

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Hi Ammity - I'm not such a fount of knowledge about meds as many others on here, but I sympathise with the bad BP depressions. I get depressed regularly, and was diagnosed BP after prozac made me manic. I had another bout of depression (along with some fairly serious paranoia) in June, and am now feeling much batter thanks to a combination of sertraline (that's the drug, think the brand name in the US is Zoloft) and Seroquel. The sertraline (50mg/day) perked me up no end, stopped me wanting to sleep all day which had been a major problem this time round. The Seroquel (100mg/twice a day) sorted out the paranoia and the pdoc tells me it's probably acting as a mood stabilizer against possible mania from the sertraline.

I don't know if telling you this helps at all. It seems to me that meds in combinations are probably the best defence against the beast.

Good luck xx

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  • 3 weeks later...

I'm bipolar and I'm experiencing depression that cannot be helped by mood stabilizers. I'm taking Lithobid and Depakote. A dr told my mom once that I shouldnt ever be on an antidepressant. So what kind of hope does that leave for me??

I just tried adding Cymbalta but had increased anxiety so quickly got off it.

I've been on a LOT of the ADs before and I really dont ever remember any of them helping... but then again the only time I've been on an AD WITH a Mood stabilizer was Lamictal 200mg with Effexor XR 150mg. Eventually I made a serious suicide attempt on that combo (but it was working for quite a while).

what kind of hope is there for a bipolar who gets REALLY depressed for long periods of time? this cant go on like this.

ps very anxious too :);)

Maybe you'll find something useful on Dr. Jim Phelps' Antidepressants That Aren't Antidepressants page?

If you have the $ you might also consider rTMS.

Good luck!

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I have had wonderful results with Zoloft at night, and WB in the AM, with Tegretol for a mood stabalizer.(I cannot take any of the atypicals--huge side effects, as well as Celexa)

I am really ADD as well, so the WB is a help in the AM.

I agree, especially with BPII, the depressions can be hell--I think this is the reason that so many of us go undiagnosed as BP for so long--cause all the docs ever see is the all-encompasing, horrible, soul-eating depression.

If you are still having that depressive part of BP, it time to talk to pdoc and see what will work for you.

Sometimes it very hard to get the right balance--but hang in there.

china

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Now we're starting to get into discussions on drugs i've never taken, like the MAOIs. are they an option? could they help? maybe they are worth discussing with your pdoc. there's also ECT, which is safe and effective these days, and produces generally great results. even though i'm bipolar, my pdoc has offered me that option because it has proven successful in bipolar patients as well.

i know it eats from the inside. before i was treated it was that swing from the deepest and darkest death inside to the heights of 'i'm god and no one can stop my greatness!'.

so the SSRI range is out totally. unfortunate, those are usually really nice meds. the atypicals seem out of range too, and those are helpful as well. that leaves only drastic measures. but in drastic situations, look at what is worse and have that deep talk with the professional you trust with your mental health care.

loon

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Actually, I have had NO PROBLEMS with the SSRI's-Zoloft in particular--and the off-breed, Wellbutrin.

I took tri-cyclics years ago, and gained about 300 lbs, and was still depressed. Prozac left me just flat--and Celexa gave me tachycardia. So--Zoloft, and WB.

But ---your mileage may vary!!

china

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I dont know what to say here...

well firstly that I stopped the Lexapro and i feel a LOT better. i mean yeah i still plot my suicide atleast once daily, but im not constantly feeling gut wrenching pain of the world 24/7 anymore. fuck SSRIS- i will never take them again until i forget how horrible they make me feel.

I'm not sure if MAOIs are an option, but considering i dont trust myself with anything dangerous and i just attempted sucide in june and almost succeeded... i dont think they are the best option with their fatal interactions with foods and other meds.

ECT may be an option in the future... like if i try to kill myself again. but i already have no memory as it is, and im 23 and frankly im just not willing to do that to my brain. id really rather be dead.

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My eyebrows were kinda creeping up my forehead reading the meds you've been on. SSRIs are generally meds of last resort for bipolars because there is a significant risk of them making you flip your lid. Even if you're unipolar there is no reason to try more than two or three. If after that many none have helped, it's generally safe to assume that serotonin is probably not your problem and move on to something else. To keep taking one after another like you've done did is just stupid. Worse, it's a waste of time and likely needlessly prolonged your suffering.

Did you ever look into provigil? If you can drink coffee you should be able to take it without a huge anxiety risk.

How much time did you give seroquel and what kind of titration schedule? If you were to combine it with provigil it would make it a lot easier to deal with the initial dopiness.

Abilify seems like an obvious choice if it doesn't cause anxiety problems.

Tegrotol is worth a look if anxiety is a problem. Look at combining it with something stimulating to deal with your existing daytime sleepiness problems and the 10 IQ points it could shave off.

You actually haven't tried that many meds. You have a lot of options left. You've just tried all the wrong ones that make no sense. Apparently you come from a place where they give toadstools licenses to practice medicine.

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oh i've been on more meds...

now wouldnt the tegretol act just like the trileptal, since they're almost the same thing??

sadly, abilify makes me clench my jaw really bad and had to stop that only a few days into it.

and right now im turning fat as fuck. and im young and pretty and starting to get unpretty because of these shit meds. i dont know what to say about seroquel cause i dont know what to think of it. i got put on 600mgs after my Overdose of Lith and Klonis and i was rageful and manic. mixed cycle mood crying and laughing at the same time. it was horrible. i was on the 150effexor and 300 lamictal at that time. it was 10 days of that in a very scary hospital. needless to say when they discharged me i spit out the seroquel and gave them a big FU as i went to another hospital cause i def was not cured... oh yeah what i meant to say was that i hvae no clue if that was the seroquel's fault or the OD. the next hospital directly after that one i was taking 25-50mgs prn to calm down... and i took it like every 4 hours... and i was still veyr rageful. i went out of that place and stopped taking it. i started to feel clearer and less rageful. but then again the lithium added at that time could have been more helpful. i think im having ADD right now bouncing from one topic to another... so i'm gonna go before ur eyes hurt.

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No I don't think Tegretol is like Tripetel--thinnk that's one of the typicals, and I really can't take those. The reaction you had to the Abilify sounds like the reactions I have to all the atypicals--

Zoloft made me fat as a pig, but the adderral is helping that--

What a mess we all are!!

china

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my problem is anxiety and depression. but i think the anxiety causes the depression.

i am almost all the ways off the Depakote. I'm crying more easily. Im not fuckin stable in moods while taking Lithium~!? WTF! perhaps my OD did irreversible brain damage.

Dr wants me back on Lamictal. Ok lady but I get RLS so I hvae ot take Cogentin with that. Not to mention the RLS might be irreversible. I don't want to go on it again.

what about Keppra or Gabitril?

oh and my dr finally broke down and gave me 6 (six) tables of klonopin. thats how she wrote it on the script-- as if i were going ot change the number. fuckin bitch, i feel like getting a new pdoc just because of that. and her reasoning for not giving me a whole bottle was that i might take the whole thing all at once. HELLO LADY IM ON LITHIUM AND U PRESCRIBE THAT and i ODed on the both of them.

why dont people understand that if we WANT to kill ourselves, then we will? taking away a very useful drug is not going to help me...

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Ammity, if they took away my klonopin, I would be such a mess that I would not be able to function and hold down a job. Stupid pdoc! I went to a pdoc ONCE! who asked if I were planning on selling or OD'ing on klonopin before prescribing it. And she gave me a look like I was a junkie or something. I feel for you. The seroquel has caused me to gain 15-20 pounds and I can't seem to lose it. But! it works wonders for the agitation, rage ,, and anxiety. Anxiety is a major issue with me, as well as depression. I got put on Prozac-20mg. about 2 months ago and it seems to have squashed my depression with just a little increase in anxiety which I think is a result of excessive caffeine consumption due to the side effects of all my other meds. What a f'ing joke! Bipolar sucks ass. Don't let it beat you. It sucks too bad. It doesn't deserve to win! Good luck and I hope you find the right combo. Considering the vast array of psychotropics(which, by the way, are not on Wal-mart's list of 4$ meds.) there is bound to be something that works. Here is what is working for me right now: lamictal-300mg., klonopin-1.5 mg, seroquel-200mg, prozac-20mg. Mel

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After a good while of OK'd -ness, here we go, down the chute again. I cannot get rid of the 15 lbs. I gained while recouping the back, and I cannot stop eating. And even with the Klonopin, I just cry off and on all day.

The Adderral helped for a while with motivation, appetite, depression, but I have, as usual, built up some kind of tolerance to it.

I hate my life--I am scared shitless I won't be able to get a job and/or get my liscense, the holidays are coming and I need to start saving money, and I can't get around feeling so useless and hopeless. My husband is officially at the end of the "Just get your back better " stage, as he should be, and is now figuring out that I am right back to being a lazy, fat asshole who can't/doesn't want to work

I have started drinking gallons of iced coffee every afternoon--super strong Starbucks that I make--just to keep me going, but its not working either. I have a pdoc appt. on Friday, thank god--and here's a real knee-slapper--he has an opening in his office for someone part-time in the front office. Probably pays shit, and if I were him I sure wouldn't hire me, but maybe I'll ask.

I have to go--I'm crying again, and so fucking mad--I hate this stupid disease, and I hate knowing I will always, always have it, and that nothing works for good, and that I am so useless and lazy and fat.

Why won't this stop? Who did I piss off, in a karmic way, that I was dumped on with this? I know that there is something to learn from every experience, I do believe that--but damn it, I don't want to learn anything else, I just want to stop hurting. I just hurt and hurt and hurt--

china

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Hi Ammity,

Sorry to hear about your woes. I too suffer from BP with severe depression and although I take loads of ADs and seds the depression bit just won't leave me be.

I'm going to offer some insight based on what I have done in the past the worked but am not following myself now.

While you're feeling total shit, the last thing you probably want to do is get out and get yourself physically fit and eat a very healthy diet. However, it most definately helps. I tell myself this daily and have done it and seen the wonderful results, but will openly admit to having no ambition at the moment.

Depressives must stay away from depressants which don't just include alcohol and drugs, but people who tax you.

Sleep is very important. Not too much, but certainly not to little.

I take lithium and prozac (both at maximum clinical levels) and was just told this week that my severity rating for depression is severe even though I really don't feel all that terrible. This lead me to think about re-setting the bar for normalcy somewhat lower than others with BP. By that I mean that when I'm manic, I'm actually normal. When I'm stable, I'm in a range that would be considered very depressed. Does that make sense? No one would ever guess talking to me. I joke around, laugh and stay active. However, clinical analysis has repeatedly shown that I'm severely depressed.

I'm interested in knowing what others who live beneath the stable line feel. I might post on that, but for now, I really wish you well. Also, it's a crap balance, but I've used valium to balance out the overload of

AD anxiety even though it makes me a little zombie. I only need it some days and even just a little half tab can sometimes chill it out.

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Roosle--I have thought for a long time that I, too, Llive "below" that stqable line. And its good to hear someone else does, too--I take Zoloft and WB, which are historically no-no's for BP folk, as they can cause mania, but the only thing that ever caused true hypomania in me was2 tablets of prednisone I was given for my back.

I have a huge tolerance for benzo's, tho--so my anxoiety is always there, bubbling under the surface of my depression. Like today--awful stuff, so I just wen to bed at 2 PM. Fortunately, when my husband got home for lunch about 3:30 he realized what was happening, tucked me in, and closed the door, so I could rest/sleep. There are time (like this) when I wouldn't trade him for the world.

If I could just STAY even close to the stable line, I'd be happy--but I am mostly down, except when I first startred the Adderall for the ADD--but that effect has worn off, too.

I know, I should be out wealking, and not just eating everything I can find, but thats my instant reaction--eat, and eat a LOT, then sleep--a LOT.

Damn this fucking disease sux.

china

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I think I also tend to run below the stable line. Most of the time we spend working on my depression; when I am manic I usually don't do anymore than make smartass comments and tell bad jokes (oh, and think I'm the smartest guy in the world). So far, the depression has been fairly resistant (partly situational), but my current cocktail (see below) in which we are slowly eliminating the effexor seems to help, some. I'm still depressed, but not as depressed as I have been other times.

Tommy

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Quick Q for Ammity,

When is the last time you had your lithium levels checked? It's just that there are moderate drug-drug interaction issues with lithium and depakote. Are you being monitored?

thanks roosle, for staying on topic.

i got off that crappy Depakote, and well... its sent me into a huge depression again...

I'm titrating up on Lamictal. My life is hell. I want to die. They shouldn't have saved me when I overdosed, and I did not ask for a fuckin breathing tube or 4k in drs bills.

i think lithium doesnt work because i cycle so quickly. i've read its really not any good for that. why i'm on it? because drs dont do their holy homework!!! well the dr said maybe itll lift my depression.

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and yes, mel, i cant work. im applying for SSD and SSI. so far the people over at ssa are TRYING to fuck you over and not give u benefits. my lady didnt set up an appt with me, but rather called me on the phone and MADE me answer the questions (or she said she'll deny my claim). i told her i am filling it out online, she said well we'd just finish it on the phone. YOUR TALKING TO A SICK PERSON HERE, LADY, DO U THINK IM READY TO ANSWER ON THE SPOT QUESTIONS?! FUCK HER. I'm going to EAster Seals tomorrow and they'll help me get a copy of my application and help me fix my answers. </rant>

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Ammity,

Your posts are sounding more stressed. Do you have someone to talk to? Now?

I've read that lithium isn't the best for rapid cycling, but I understand your dislike of Depakote. I hated it too.

Just a thought and certainly not one to increase your bills, but is there anywhere that you can check yourself in and get some 'round the clock' care? Maybe the thing to do right now is chill out and get stable.

Keep us posted on what's going on.

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Ammity,

Your posts are sounding more stressed. Do you have someone to talk to? Now?

I've read that lithium isn't the best for rapid cycling, but I understand your dislike of Depakote. I hated it too.

Just a thought and certainly not one to increase your bills, but is there anywhere that you can check yourself in and get some 'round the clock' care? Maybe the thing to do right now is chill out and get stable.

Keep us posted on what's going on.

Hi. I can check myself in... I think my insurance would cover it since it's emergency, and just charge me the $100 copayment. My psychiatrist wanted me to check myself in too, or else go to acute partial hospitalization... I want neither. All I really want to do right now is wait for the Lamictal to kick in, play on my pc, and sleep. Occasionally go work out and hang out with friends on the weekend. Thats all I want to do right now and I really think I'm entitled to it. My brain broke, I overdosed it, and on top of that my body is probably physically healing because I was on a breathing tube and such.

I need a break, yes, and I'd rather have my pc handy on this break because I can escape through it... but my family doesnt understand the need for the break, they want me to get out there and do shit. I can't, I'm trying to stay alive. But again, I promised people that I would check myself in if i didn't feel safe. Today I feel safe.

But I'm getting ready. I'm putting songs on an ipod now. I'll drag out my coloring books, shampoo and stuff. Maybe I'll just keep a packed bag.

See, I just don't want to go in there and then just come out the same way. Its stresful to go inpatient, and I'ev always gone and they fucked with my meds and I came out feeling terrible and had to readjust them. And they can't ramp up the Lamictal quickly either, so whats the point?

I mean, hospitals are there so u dont kill urself or someone else, right? I wonder if my therapist who works on a different floor would come see me and have a meeting if i was inpatient. Its almost tempting for me to go now... if they gave me meds to calm down. hah, fat chance. somehow i'm doomed to never get anything that makes me feel better, like Xanax.

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Effexor is the Drug From Hell for BP's,mostly because it hikes up your anxiety to unacceptable levels. I am always amazed when I see someone here listing Effexor as part of their current cocktail.

Paint from a broad brush much? I had terrible rapid cycles into depression that lasted pretty much all of last year. Topamax didn't work, and my seroquel and lamictal couldn't keep up. I started Effexor about 4 months ago and it has been a MIRACLE. I feel human once again, and am amazed at how depressed I really was, now that I'm not there. I had about a week of feeling anxious and a little hypomanic, but nothing that wasn't manageable.

I still take the seroquel, although I've titrated down to just 400mg a day, all at night. The lamictal stays.

Whatever works for you, I say. Each one of our brains is different, even though we share common disorders.

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